Provider Demographics
NPI:1942582440
Name:SHAMS, NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:SHAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NAZANIN
Other - Middle Name:
Other - Last Name:SHAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:16144 NE 87TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3505
Mailing Address - Country:US
Mailing Address - Phone:425-556-0202
Mailing Address - Fax:425-556-0202
Practice Address - Street 1:16144 NE 87TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3505
Practice Address - Country:US
Practice Address - Phone:425-556-0202
Practice Address - Fax:425-556-0202
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60563438152W00000X
NY007153152W00000X
WAOD 60563438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60563438OtherWA LICENSE #